Anterior Drawer Test Of The Shoulder

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed

Purpose

Anterior Drawer Test of the shoulder is used to examine the Anterior shoulder instability.

Technique

Step1. Patient in supine position.

Step2. Relax the affected shoulder by holding patients arm ( or placing hand on axilla) with therapist one hand.

Step3. Abduct the patient shoulder between the 80 and 120 degree, Forward flexed up to 20 degree, laterally rotated up to 30 degree.

Step4. Stabilize the patient scapula with the therapist opposite hand by pushing the spine of the scapula with index and middle finer. Applying counterpressure on patients coracoid process with the therapist thump.

Step5. Draws the humerus forward (anteriorly) using the hand that is holding patients arm (or placing hand on axilla).

Step6. Positive test indicates the anterior instability decided by the amount of anterior translation which is accessible comparing with the normal side.

[1]
Grade Diagnosis
grade 0 Minimal displacement
grade 1 Humeral head reaches glenoid rim
grade 2 Humeral head can be dislocated but spontaneously resolved
grade 3 Humeral head does not spontaneously reduce

The click may indicate a labral tear or slippage of the humeral head over the glenoid rim.[2]

[3]

Evidence

Sensitivity = 0.53

Specificity = 0.85

Positive likelihood ratio (+LR) = 3.6

Negative likelihood ratio (-LR) = 0.57[4]

The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability.[4]


References

  1. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  1. Lizzio VA, Meta F, Fidai M, Makhni EC. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017;10(4):434-441. doi:10.1007/s12178-017-9434-3
  2. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  3. Shoulder - Anterior Drawer Test. Physiotherapy University College Copenhagen. Available from: https://youtu.be/G8s_7Q5zfTM%7C300
  4. 4.0 4.1 Farber AJ, Castillo R, Clough M, Bahk M, McFarland EG. Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am. 2006;88(7):1467-1474. doi:10.2106/JBJS.E.00594